Letter to the Editor Regarding “Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional versus General Anesthesia”

2022 ◽  
Vol 157 ◽  
pp. 243
Author(s):  
Jiali Peng ◽  
Jue Jiang
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Opioid Use ◽  
Letter To The Editor

scholarly journals Long-term postoperative opioid prescription after cholecystectomy or gastric by-pass surgery: a retrospective observational study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Viktoria Larsson ◽  
Cecilia Nordenson ◽  
Pontus Karling
Keyword(s):  
Observational Study ◽  
Postoperative Period ◽  
Medical Records ◽  
Early Postoperative Period ◽  
Retrospective Observational Study ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Post Surgery ◽  
Gastric By Pass

Abstract Objectives Opioids are commonly prescribed post-surgery. We investigated the proportion of patients who were prescribed any opioids 6–12 months after two common surgeries – laparoscopic cholecystectomy and gastric by-pass (GBP) surgery. A secondary aim was to examine risk factors prior to surgery associated with the prescription of any opioids after surgery. Methods We performed a retrospective observational study on data from medical records from patients who underwent cholecystectomy (n=297) or GBP (n=93) in 2018 in the Region of Västerbotten, Sweden. Data on prescriptions for opioids and other drugs were collected from the patients` medical records. Results There were 109 patients (28%) who were prescribed opioids after discharge from surgery but only 20 patients (5%) who still received opioid prescriptions 6–12 months after surgery. All 20 of these patients had also been prescribed opioids within three months before surgery, most commonly for back and joint pain. Only 1 out of 56 patients who were prescribed opioids preoperatively due to gallbladder pain still received prescriptions for opioids 6–12 months after surgery. Although opioid use in the early postoperative period was more common among patients who underwent cholecystectomy, the patients who underwent GBP were more prone to be “long-term” users of opioids. In the patients who were prescribed opioids within three months prior to surgery, 8 out of 13 patients who underwent GBP and 12 of the 96 patients who underwent cholecystectomy were still prescribed opioids 6–12 months after surgery (OR 11.2; 95% CI 3.1–39.9, p=0,0002). Affective disorders were common among “long-term” users of opioids and prior benzodiazepine and amitriptyline use were significantly associated with “long-term” opioid use. Conclusions The proportion of patients that used opioids 6–12 months after cholecystectomy or GBP was low. Patients with preoperative opioid-use experienced a significantly higher risk of “long-term” opioid use when undergoing GBP compared to cholecystectomy. The indication for being prescribed opioids in the “long-term” were mostly unrelated to surgery. No patient who was naïve to opioids prior surgery was prescribed opioids 6–12 months after surgery. Although opioids are commonly prescribed in the preoperative and in the early postoperative period to patients with gallbladder disease, there is a low risk that these prescriptions will lead to long-term opioid use. The reasons for being prescribed opioids in the long-term are often due to causes not related to surgery.

scholarly journals Comparative analysis of the results of cochlear implantation under general and local anesthesiain patients with comorbid pathology

2021 ◽  
Vol 23 (3) ◽  
pp. 250-255
Author(s):  
Khassan M.A. Diab ◽  
◽  
Khassan M.A. Diab ◽  
Nikolai A. Daikhes ◽  
Nikolai A. Daikhes ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Comparative Analysis ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Postoperative Period ◽  
Cochlear Implantation ◽  
Early Postoperative Period ◽  
Main Group ◽  
Control Group ◽  
Fourth Degree

The article is devoted to an urgent problem – the correction of hearing impairment in patients with concomitant diseases. The results of a comparative analysis of data from patients with somatic diseases who underwent cochlear implantation (CI) for severe to profound hearing loss hearing loss of the fourth degree and deafness under local and general anesthesia are presented. Materials and methods. On the basis of the National Medical Research Center for Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, CI was performed under local anesthesia for 10 patients with concomitant diseases, which represented difficulties for the use of general anesthesia (main group). All patients in the preoperative stage precisely informed about each stage of the surgery and with the cue-cards (with questions) to maintain contact with them during CI. The control group consisted of 10 patients who underwent CI under general anesthesia. CI was performed according to a standard technique. After the operation, a survey of patients of both groups about subjective sensations during the operation and in the early postoperative period was carried out. Results. CI under local anesthesia takes an average of 18±5.2 min, taking into account the time of anesthesia, which is 15±5.3 min less than with general anesthesia (p<0.001). When performing CI under local anesthesia, clear thresholds for recording acoustic reflexes stapedial muscle are determined, since in this case the effect of muscle relaxants is excluded. Against the background of local anesthesia, the necessary effect was achieved rather quickly, there was no increase in blood pressure to high numbers, patients answered all the signs and questions by reading the information from the cue-cards. A survey of patients revealed a good tolerance to local anesthesia. The number of patients in the main group which had a complaints in the early postoperative period was less than in the control group (p<0.05). The duration of hospital staying in patients of the main group averaged 1.15 days (from 1 to 3 days), which is significantly less than in the control group – from 3 to 7 days, on average 4.05 days (p<0.05). When conducting CI under local anesthesia, none of the patients showed a destabilization of comorbidity pathology in the postoperative period. Conclusion. CI under local anesthesia in patients with concomitant pathology has several advantages over general anesthesia. The use of local anesthesia will increase the availability of CI for elderly comorbid patients and mitigate the risks of general anesthesia.

scholarly journals DEXMEDETOMIDINE AS A COMPONENT OF ANESTHESIAAND PROMISING BASE FOR OPIOID FREE ANALGESIA

2018 ◽  
Vol 12 (2) ◽  
pp. 82-90
Author(s):  
Alexei M. Ovechkin ◽  
M. E Politov ◽  
E. L Bulanova
Keyword(s):  
General Anesthesia ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Intravenous Infusion ◽  
Opioid Analgesics ◽  
Early Postoperative Period ◽  
Inhalation Anesthetics ◽  
Intravenous Anesthetics ◽  
Average Pain Intensity ◽  
Average Pain

Data suggests that intravenous infusion of dexmedetomidine, started 15-20 minutes before the induction of general anesthesia, can significantly reduce the doses of intravenous anesthetics, MAC of inhalation anesthetics, and requirements in opioid analgesics during the surgery. Intraoperative infusion of dexmedetomidine prolongs the time of the first requirement of analgesics after surgery, reduces the average pain intensity in the early postoperative period, and also requirements in opioid analgesics.

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